Provider Network Reports. The Contractor shall submit a report to the Department, in a format specified by the Department, to demonstrate that the Contractor offers an appropriate range of Covered Services that is adequate for the anticipated number of Enrollees in the Service Area and that the Contractor maintains a network of Providers that is sufficient in number, mix and geographic distribution to meet the needs of the anticipated number of Enrollees in the Service Area.
Provider Network Reports. 91 12.6 MEMBER COMPLAINTS....................................91 12.7
Provider Network Reports. The Contractor shall submit a monthly electronic file of its Participating Provider network that meets the Department’s provider file specifications and data element requirements to the Department.
Provider Network Reports. 12.5.1 Provider Network Report. HMO must submit to the Enrollment Broker an electronic file summarizing changes in HMO's provider network including PCPs, specialists, ancillary providers and hospitals. The file must indicate if the PCPs and specialists participate in a closed network and the name of the delegated network. The electronic file must be submitted in the format specified by TDH and can be submitted as often as daily but must be submitted at least weekly.
Provider Network Reports. The CONTRACTOR shall notify HSD within five (5) working days of any unexpected changes to the composition of its provider network that negatively affects member access or the CONTRACTOR'S ability to deliver all services included in the benefit package in a timely manner. Any anticipated material changes in the CONTRACTOR'S provider network shall be reported to HSD in writing when the CONTRACTOR knows of the anticipated change or within thirty (30) calendar days, whichever comes first. The notice submitted to HSD shall include the following information: Nature of the change; Information about how the change affects the delivery of covered services or access to the services; and the CONTRACTOR'S plan for maintaining the access and quality of member care.
Provider Network Reports. Contractor shall submit to DHCS, in a format specified by DHCS, a report summarizing changes in the Provider Network.
A. The report shall be submitted at a minimum:
1) Quarterly
2) At the time of a Significant Change, as defined in this Contract and set forth in 42 CFR 438.207 and APL 21-006, to the Network affecting Provider capacity and services, including:
a) Change in services or benefits;
b) Geographic service area or payments; or
c) The composition of, or the payments to, it’s Network; or
d) Enrollment of a new population.
B. The report shall identify the following for each termination resulting in a network impact:
1) Geographic access maps for the Members;
2) The percentage of Traditional and Safety-Net Providers;
3) The number of Members assigned to each provider type or facility;
4) The percentage of Members assigned to Traditional and Safety-Net Providers; and
5) The Network Providers who are not accepting new patients.
C. Contractor shall submit the report 30 calendar days following the end of the reporting quarter.
D. Contractor shall participate annually in the submission to DHCS of its Provider Network composition report to demonstrate its capacity to serve the current and expected membership in its Service Area in accordance with State standards for access and timeliness of care, 42 CFR 438.207(b), and APL 21-006.
1) Contractor shall demonstrate how it will arrange for Covered Services to Members through the use of NEMT, NMT, and Telehealth if Contractor does not meet time or distance standards for adult and pediatric PCPs, core Specialist and outpatient mental health Providers in accordance with W&I Section 14197(f)(2).
Provider Network Reports. (a) PCPs and Specialists Report CONTRACTOR must submit to HHSC by the date of the readiness review an electronic listing of all PCPs participating in their network. The format for this report is contained in Appendix K. CONTRACTOR must also submit to HHSC by the date of the readiness review an electronic listing of all specialists participating in their network. The format for this report is contained in Appendix L to the RFP.
(b) Provider Network Change Report CONTRACTOR must submit a monthly report summarizing changes in CONTRACTOR's provider network. The report must be submitted to HHSC in the format set out in the RFP 30 days following the end of the reporting month.
(c) PCP Network and Capacity Report CONTRACTOR must submit electronically to the Administrative Services Contractor a weekly report that shows changes to the PCP network and PCP capacity.
Provider Network Reports. 12.5.1 Provider Network Change Reports. HMO must submit a monthly report summarizing changes in HMO's provider network. The report must be submitted to TDH in the format specified by TDH. HMO will submit the report thirty (30) days following the end of the reporting month. The report must identify provider additions and deletions and the impact to the following:
(1) geographic access for the Members;
(2) cultural and linguistic services;
(3) the ethnic composition of providers;
(4) the number of Members assigned to PCPs;
(5) the change in the ration of providers with pediatric experience to the number of Members under age 21; and El Paso Service Area HMO Contract
(6) number of specialists serving as PCPs.
Provider Network Reports. 2.30.7.1 The CONTRACTOR shall submit a monthly Provider Enrollment File that includes information on all providers of TennCare health services, including physical and behavioral health providers (see Section 2.11). This includes but is not limited to, PCPs, physician specialists, hospitals, home health agencies, CMHAs, and emergency and non-emergency transportation providers. The report shall include contract providers as well as all non-contract providers with whom the CONTRACTOR has a relationship. The report shall be sorted by provider type. The CONTRACTOR shall submit this report in the format to be prescribed by TENNCARE. The CONTRACTOR shall submit this report during readiness review, by the 5th of each month, and upon TENNCARE request. Each monthly Provider Enrollment File shall include information on all providers of TennCare health services and shall provide a complete replacement for any previous Provider Enrollment File submission. Any changes in a provider’s contract status from the previous submission shall be indicated in the file generated in the month the change became effective and shall be submitted in the next monthly file.
2.30.7.2 The CONTRACTOR shall submit an annual Provider Compliance with Access Requirements Report that summarizes the CONTRACTOR’s monitoring activities, findings, and opportunities for improvement regarding provider compliance with applicable access standards. (See Section 2.11.1.10.)
2.30.7.3 The CONTRACTOR shall submit a quarterly PCP Assignment Report that provides information on members not assigned to a primary care provider (PCP) within thirty (30) calendar days of enrollment or prior to the member’s beginning effective date. This report shall be submitted using the format provided in Attachment IX, Exhibit F. (See Section 2.11.2.)
2.30.7.4 The CONTRACTOR shall submit an annual Report of Essential Hospital Services by September 1 of each year. The CONTRACTOR shall use the format in Attachment IX, Exhibit G.
2.30.7.5 The CONTRACTOR shall submit a quarterly Behavioral Health Initial Appointment Timeliness Report that shall include the average time between the intake assessment appointment and the member’s next scheduled appointment or admission. The report shall provide this information by type of service and shall include an analysis of the findings and any actions or follow-up planned as a result of the findings. The report shall be submitted in a format prescribed by TENNCARE.
2.30.7.6 The CONTRACTOR shall su...
Provider Network Reports. 2.30.7.1 The CONTRACTOR shall submit a monthly Provider Enrollment File that includes information on all providers of TennCare health services, including physical, behavioral health, and long-term care providers (see Section 2.11). This includes but is not limited to, PCPs, physician specialists, hospitals, home health agencies, CMHAs, nursing facilities, HCBS providers, and emergency and non-emergency transportation providers. For HCBS providers, the Provider Enrollment File shall identify the type(s) of HCBS the provider is contracted to provide and the specific counties in which the provider is contracted to deliver HCBS, by service type. The report shall include contract providers as well as all non-contract providers with whom the CONTRACTOR has a relationship. The report shall be sorted by provider type. The CONTRACTOR shall submit this report during readiness review, by the 5th of each month, and upon TENNCARE request. Each monthly Provider Enrollment File shall include information on all providers of covered services and shall provide a complete replacement for any previous Provider Enrollment File submission. Any changes in a provider’s contract status from the previous submission shall be indicated in the file generated in the month the change became effective and shall be submitted in the next monthly file.
2.30.7.2 The CONTRACTOR shall submit an annual Provider Compliance with Access Requirements Report that summarizes the CONTRACTOR’s monitoring activities, findings, and opportunities for improvement regarding provider compliance with applicable access standards. (See Section 2.11.1.10.)
2.30.7.3 The CONTRACTOR shall submit a quarterly PCP Assignment Report that provides the following information for non-dual members: Provider Name, Provider Medicaid I.D. Number, NPI Number, Number of Enrollees assigned by Enrollee Age Category. The enrollee age categories shall be consistent with the following: Age Under 1, Age 1-13, Age 14-20, Age 21-44, Age 45-4, Age 65 +. This report shall be submitted using the format provided in Attachment IX, Exhibit F. (See Section 2.11.2.)
2.30.7.4 The CONTRACTOR shall submit an annual Report of Essential Hospital Services by September 1 of each year. The CONTRACTOR shall use the format in Attachment IX, Exhibit G.
2.30.7.5 The CONTRACTOR shall submit a quarterly Behavioral Health Initial Appointment Timeliness Report that shall include the average time between the intake assessment appointment and the member’s next s...
